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At least 541 records · Page 30Linked to original sources
PubMed2006

Pregnancy and delivery in patients with enterostomy due to anorectal complications from Crohn's disease.

BACKGROUND AND AIMS: Enterostomy is often undergone by patients with Crohn's disease (CD) due to severe anorectal lesions such as rectovaginal fistula (RVF). Reports of successful pregnancy and delivery, which are important determinants of quality of life for female CD patients with stoma, are limited. Thus, we investigated problems associated with pregnancy and delivery in female CD patients at our hospital. MATERIALS AND METHODS: Between 1985 and 2003, five female CD patients with enterostoma carried seven pregnancies and delivered eight babies in our hospital. For this study, we investigated CD activity, fetal growth, stoma complications, and the outcome of delivery in these seven pregnancies. RESULTS: Among the five patients, four underwent loop ileostomy and one loop sigmoidostomy for treatment of RVF or severe stricture of the rectum or sigmoid colon. Except for one case, no fertility treatment was done. During pregnancy, a flare-up was observed in one patient and was successfully treated with corticosteroids. Although home enteral or parenteral nutrition was required in two cases, fetal growth was within the normal range in all pregnancies. Preterm delivery occurred in one case with a twin pregnancy. The mean diameter of stoma increased during pregnancy (p<0.01), and a mucosal laceration of stoma by the edge of an ostomy appliance occurred in one case. All deliveries were safe, with six cesarean sections and one transvaginal delivery. After each delivery, the stoma returned to pre-pregnancy size. CONCLUSIONS: Pregnancy and delivery in CD patients with stoma is safe and should be encouraged. However, special attention to disease activity, nutritional support, and stoma-related complications is recommended.

Adult↗
PubMed2005

Total laparoscopic proctocolectomy with Brooke ileostomy: a novel incisionless surgical treatment for patients with ulcerative colitis.

BACKGROUND: This report describes the clinical benefits and safety of a novel (incisionless) laparoscopic operation for chronic ulcerative colitis. METHODS: The medical records for four patients with the diagnosis of chronic ulcerative colitis who underwent "incisionless" laparoscopic proctocolectomy with Brooke ileostomy were reviewed. A novel technique was used for successfully performance of four total proctocloectomies with end ileostomies that did not require abdominal incisions. The clinical outcomes measured included time to oral intake, time to ostomy output, operative time, postoperative and intraoperative complications, estimated blood loss, and length of stay. RESULTS: All the patients recovered without incident intraoperatively and postoperatively. The operative times ranged from 330 to 550 min. Postoperative findings included median time to oral intake (2 days), median time to ileostomy output (2 days), and median length of stay (4 days). CONCLUSION: This case series demonstrates that an incisionless approach to chronic ulocerative colitis for patients who desire an end ileostomy may be feasible and safe, offering patients short-term recovery and cosmetic benefits.

Aged↗
PubMed2000

Laparoscopic gastrostomy.

Although percutaneous endoscopic gastrostomy (PEG) has become a common technique for the placement of gastrostomy tubes, gastrostomy can be performed via the laparoscopic approach with minimal trauma or by using a percutaneous gastrostomy kit. In this report, we describe two procedures for laparoscopic gastrostomy using standard instruments. Standard laparoscopic techniques are used to create a pneumoperitoneum. In the first method, three transparieto-transgastric U stitches are placed to surround the site selected for the gastrostomy. A Foley catheter is inserted through the abdominal and gastric opening, then tied to the stomach with a pursestring suture. Traction on the balloon catheter brings the stomach to the anterior abdominal wall, where the three U stitches can be tied. In the second method, a 9-cm vascularized isoperistaltic gastric tube is made on the greater curvature using an endoscopic linear cutter and preserving the gastro-omental vessels. This gastric tube is then brought out through the anterior abdominal wall via a trocar orifice, opened, and fixed to the skin as for standard ostomy. Laparoscopic gastrostomy is a straightforward procedure that reduces postoperative pain and ileus. It obviates the need for a laparotomy while creating an adequate gastrostomy. Postoperative recovery is prompt, with rapid return of intestinal function and early discharge from the hospital. It not only represents an alternative to PEG when this route is not suitable or after failure of the procedure, but can also be widely used for patients as a first choice.

Abdominal Muscles↗
PubMed2003

Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome.

Nephrotic patients are at risk of developing venous and arterial thrombotic complications. Pulmonary embolism due to affected deep leg veins is by far the most common event. Renal or cerebral vein thromboses have been described. Thrombosis of arterial vessels is less frequent. Mesenteric infarction is a rare but severe complication in patients with nephrotic syndrome (NS). We report a 7-year-old boy with a steroid-dependent (SD) NS and a homozygous mutation of methylenetetrahydrofolate reductase, increasing the risk of thromboembolic events. He developed a thrombosis of his superior mesenteric artery during his ninth relapse, which was responsible for a necrosis of 240 cm of his small bowel, necessitating resection of necrotic parts and double external ostomy diversion. Remission was achieved with pulse prednisolone therapy. Corticoids were reduced over 4 months progressively. Oral cyclosporin A (CyA) was initiated for long-term treatment. Due to a short bowel syndrome with severe malabsorption, even oral administration of 22.5 mg/kg per day CyA did not lead to sufficient plasma levels. Intravenous cyclophosphamide pulse therapy over 6 months led to a complete remission. No relapse occurred over a period of more than 5 months after the last cyclophosphamide pulse. Anticoagulation and screening for increased susceptibility for thrombotic events are necessary in every nephrotic patient. Intravenous cyclophosphamide pulse therapy is a useful alternative in SDNS with impaired intestinal absorption of applied immunosuppressive drugs.

Child, Preschool↗
PubMed2005

Surgical salvage of recurrent rectal cancer after transanal excision.

PURPOSE: This study examines surgical salvage of locally recurrent rectal cancer following transanal excision of early tumors. METHODS: Through retrospective review of a colorectal database we identified 50 patients who underwent attempted surgical salvage for local recurrence following initial transanal excision of T1 or T2 rectal cancer. Eight patients had resectable synchronous distant disease. Clinicopathologic variables were associated with extent of surgery required for salvage and outcome. RESULTS: Salvage procedures included abdominoperineal resection (31), low anterior resection (11), total pelvic exenteration (4), and transanal excision (3). One patient had unresectable disease at exploration, requiring diverting ostomy. Of the 49 patients who underwent successful salvage, 27 (55 percent) required an extended pelvic dissection with en bloc resection of one or more of the following structures: pelvic sidewall and autonomic nerves (18); coccyx or portion of sacrum (6); prostate (5); seminal vesicle (5); bladder (4); portion of the vagina (3); ureter (2); ovary (1); and uterus (1). Complete pathologic resection (R0) was accomplished in 47 of 49 patients. Of the eight patients with distant and local recurrence, two underwent synchronous resection and six had delayed metastasectomy. With a median follow-up of 33 months, 29 patients had recurred or died of disease at the time of this analysis. Five-year disease-specific survival was 53 percent. Factors predictive of survival included evidence of any mucosal recurrence on endoscopy, low presalvage carcinoembryonic antigen, and absence of poor pathologic features (lymphovascular and perineural invasion). Patients who required an extended pelvic resection had a worse survival rate. CONCLUSION: Pelvic recurrence following transanal excision of early rectal cancer is often locally advanced, requiring an extended pelvic dissection with en bloc resection of adjacent pelvic organs to achieve salvage. The long-term outcome in patients undergoing resection is less than expected, considering the early stage of their initial disease. When contemplating local excision for early rectal cancer, the risk of local recurrence, the extent and morbidity of surgery required for salvage, and the modest cure rate following salvage should be considered.

Adult↗
PubMed2006

A stoma quality of life scale.

PURPOSE: Few studies have evaluated the impact of a stoma on patient quality of life because of a lack of specific validated measures. This study documents the development and initial application of a Stoma Quality of Life Scale. METHODS: Content experts generated initial questions. Patient focus groups were conducted to ensure that the questions addressed all stoma-related issues considered important by patients. Responses from pilot groups allowed refinement to produce the final measure, the Stoma Quality of Life Scale, a 21-item questionnaire. Three scales are featured: Work/Social Function (6 items), Sexuality/Body Image (5 items), and Stoma Function (6 items). In addition, one item (scored separately) measures financial impact, one measures skin irritation, and two measure overall satisfaction. This questionnaire was administered to 100 consecutive ostomy patients, and readministered three weeks later. Reliability was assessed by using coefficient alpha for internal consistency and intraclass correlation coefficient for test-retest reproducibility. To test validity in extreme groups, scores were compared for patients with improved quality of life vs. those whose stoma worsened their quality of life. To evaluate convergent validity, we analyzed correlation of instrument scales with the SF12. RESULTS: The Stoma Quality of Life scales demonstrated adequate test-retest reproducibility (intraclass correlation coefficient>0.8) and acceptable internal consistency (coefficient alpha approximately 0.8). The scales were capable of discriminating between patients with better and worse quality of life after stoma formation (P<0.02 for all scales). The Stoma Quality of Life scales significantly correlated (range, 0.12-0.75) with the Physical and Mental Health Composite Scale Scores of the SF-12. CONCLUSIONS: The Stoma Quality of Life Scale demonstrates reasonable psychometric properties for measuring quality of life in patients with stomas. Further studies are needed to refine the instrument.

Adult↗
PubMed2003

Treatment of Fistulizing Crohn's Disease in Children.

Patients with Crohn's disease are at risk for developing both internal and external fistulae. These can be asymptomatic incidental radiologic findings or causes of incontinence, chronic pain, abscesses, and sepsis. They can have a devastating impact on quality of life. Careful prospective studies of therapy are few in adult medicine and entirely lacking in the pediatric age group. Assessment and management require a coordinated effort between gastroenterologist, radiologist, and surgeon. Principles of management include surgical drainage of infection combined with medical therapy. Only infliximab has been studied in prospective, double-blinded fashion and clearly shown to be of use in the short term. There is good evidence that metronidazole may be useful acutely and that 6-mercaptopurine azathioprine may help to maintain closure. Diverting ostomies are of very limited value and corticosteroids seem to make matters worse. There are many other therapies that have been reported to be helpful in small, uncontrolled studies.

Journal Article↗
PubMed1992

Factors influencing wound dehiscence.

Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p less than 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died.

Abdominal Muscles↗
PubMed1982

Reduction of generalized aversive responding in a post-treatment cancer patient: relaxation as an active coping skill.

A male ostomy patient was successfully taught relaxation as an active coping skill to control generalized aversive gastric upset responses which had originally developed in the context of radiation therapy. Because the patient had completed his medical regimen, intervention focused on applied relaxation outside the medical center setting. Treatment involved minimal therapist contact. The results are discussed in terms of assessing aversive side effects which generalize beyond the course of medical treatment, and the contingent aspects of such treatments. The efficiency of relaxation programs, as well as the importance of active patient involvement, are also discussed.

Adaptation, Psychological↗
PubMed1995

Collagenous colitis and fecal stream diversion.

BACKGROUND & AIMS: The cause of collagenous colitis is unknown. Data on treatment are sparse, and surgical therapy has not been reported. This study reports results of surgical therapy for collagenous colitis. METHODS: Nine women with unresponsive collagenous colitis underwent surgery. An ileostomy was performed as the first procedure in 8 patients, and a sigmoidostomy using the Hartmann procedure was performed in 1 patient. RESULTS: Preoperatively, all patients had severe diarrhea, and the median thickness of the subepithelial collagenous layer was 20 microns (range, 10-40 microns). Postoperatively, diarrhea ceased in all patients, and the collagen layer was reduced to 2 microns (range, 0-10 microns). Clinical symptoms and the abnormal collagen layer recurred after restoration of intestinal continuity. After the Hartmann procedure, the collagen layer remained abnormally thickened up to 30 microns in the proximal colon but was normalized in the excluded rectosigmoid colon. One year later, the sigmoidostomy was replaced by a split ileostomy; at follow-up, the collagen layer was normal in the whole colon. CONCLUSIONS: Fecal stream diversion induced clinical and histopathologic remission in collagenous colitis. After closure of the ostomy, clinical symptoms and the abnormal collagen layer recurred. The findings strongly indicate that a noxious luminal factor is of pathogenetic importance. In older patients with medically resistant disease, a split ileostomy may be the therapeutic procedure of choice.

Adult↗
PubMed1993

Risk of infection, infecting flora and treatment considerations in penetrating abdominal trauma.

Infectious complications postoperatively for penetrating abdominal trauma are a major cause of morbidity, which contributes significantly to increased length of hospitalization stay and the cost of patient care. The results of recent studies have suggested that the probability of a major infection after traumatic intestinal perforation of the individual patient can be predicted from risk factors noted at the time of the operation. The factor most closely associated with the development of infection is peritoneal contamination by intestinal contents. Other significant risk factors (p < 0.05) are the number of organs injured, number of units of blood administered, ostomy formation for left colonic injury and patient age. The risk of patients being infected can be predicted and thereby used to guide postoperative treatment decisions. Adjusting trauma care choices in antibiotics, duration of antibiotic administration and incisional wound management could result in significant savings. Standard operative procedures, the use of parenteral antibiotics (the duration of which has been one to two days in most recent studies) effective against endogenous aerobic and anaerobic organisms and leaving the surgical incision open decrease the incidence of postoperative wound infection. Despite such preventive measures, major infection remains a problem.

Abdominal Injuries↗
PubMed1985

Evaluation of new nonadhesive urostomy system.

The new Vance nonadhesive urostomy system has several advantages over established systems, including ease of assembly, cleanliness, large and less visible storage capacity, and security from leakage. We studied 44 patients using this system, including those who were previously satisfied with more established ostomy systems and those with stomal problems. We found the new system to be superior in most of the patients.

Evaluation Studies as Topic↗
PubMed1985

Intubated cutaneous ureterostomy: option for high-risk patients needing supravesical urinary diversion.

Failure of primary healing between ureter and skin has led to numerous complications and the virtual abandonment of cutaneous ureterostomy. When an indwelling double-J stent can be maintained, primary healing occurs and good ureterocutaneous anastomoses result. Ostomy training is only slightly more difficult than in patients with an ileal conduit urinary diversion and has presented no major problems. We now favor cutaneous ureterostomy in selected high-risk patients because of the lesser magnitude of this form of supravesical urinary diversion and, especially, because intubation has overcome most of the complications of this procedure.

Aged↗
PubMed1992

Complications of colostomy performed on gynecologic cancer patients.

From 1/1/80 to 5/31/90 111 patients underwent a colostomy on a gynecologic oncology service. Six patients developed 7 (6.3%) early colostomy-related complications, including sepsis (1), stomal retraction (1), ostomy wound infection (3), and partial stomal obstruction (2). The sepsis was felt to be related to spillage of stool upon maturing the colostomy, and this patient expired on Postoperative Day 63. There were no other mortalities attributed to the colostomies. Fourteen patients developed 17 (15.3%) delayed colostomy-related complications, including parastomal hernia (5), stomal retraction (1), stomal prolapse (3), tumor replacement (2), and site-choice problems (6). These results compare favorably with those in the literature and support the continued role of the gynecologic oncologist in gynecologic cancer-related gastrointestinal surgery.

Adult↗
PubMed1992

Peristomal pyoderma gangrenosum.

A patient with Crohn's disease and peristomal pyoderma gangrenosum is described. This patient is unique because she had a rapid response to intralesionally injected steroids. This treatment is ideal for peristomal pyoderma gangrenosum because it is administered intermittently when the ostomy appliance is changed and it does not interfere with adhesion of the device. All 11 cases of peristomal pyoderma gangrenosum described in the literature are reviewed.

Abdominal Muscles↗
PubMed2006

Colorectal resection in patients with ovarian and primary peritoneal carcinoma.

OBJECTIVE: This study examines the operative details and complications of colorectal resection in patients with ovarian and primary peritoneal carcinoma. STUDY DESIGN: Patients who underwent colorectal resection for ovarian and primary peritoneal cancer were identified in our surgical database for the period 1988 through 2002. RESULTS: Of the 125 patients who were identified, 73% were undergoing primary cytoreduction; 18% were undergoing secondary cytoreduction, and 7% were undergoing interval cytoreduction. The mean length of colon that was removed was 15.7 cm. The method of anastomosis was stapler in 63% and hand sewn in 22%; 15% patients had no anastomosis performed. A protective ostomy was used in 13% of patients. Optimal cytoreduction (<1 cm) was achieved in 74%. Operative complications occurred in 37% of patients, with the most common being hemorrhage (25%). Anastomotic leaks occurred in 2.5% of the patients, and the most common postoperative complication was ileus (28%). Postoperative bowel function returned to normal in 71% of patients. CONCLUSION: To obtain optimal cytoreduction in patients with ovarian cancer, colorectal resection often is necessary. Colorectal resection can be performed with a low risk of anastomotic complications, and patients frequently have the return of normal bowel function.

Adult↗
PubMedDate not supplied

Porcine dermal collagen (Permacol) for abdominal wall reconstruction.

OBJECTIVE: A review of Eisenhower Army Medical Center's experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects. METHODS: Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol. RESULTS: From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient). At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred. CONCLUSION: Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.

Abdominal Abscess↗
PubMed2003

Short bowel syndrome and Crohn's disease.

Patients with Crohn's disease are at high risk for recurrent disease and often undergo multiple operations. Our aims were to evaluate surgical management and outcome of patients with Crohn's disease who develop short bowel syndrome (SBS) and to identify factors leading to this complication. We reviewed the records of 170 adult patients with SBS evaluated over a 20-year period. Thirty (18%) had Crohn's disease. SBS was defined as an intestinal remnant less than 180 cm with associated malabsorption. There were 20 women and 10 men ranging in age from 18 to 62 years. Eighteen (60%) presented initially with ileocolonic disease, seven (23%) with colonic disease, and five (17%) with small intestinal disease. The interval from initial diagnosis to development of SBS ranged from 2 to 32 years, with 21 patients (71%) having an interval greater than 15 years. The number of resections leading to SBS varied from 2 to 12 with 24 patients (80%) having four or fewer resections. Nineteen patients (63%) had an ostomy. Small intestinal remnant length was less than 60 cm in 10 patients, 60 to 120 cm in six patients, and greater than 120 cm in 14 patients. Only one patient underwent stricturoplasty before developing SBS. Five patients were initially diagnosed as having ulcerative colitis and underwent a pouch procedure, which was subsequently resected. Twenty patients (67%) required parenteral nutrition. Three patients have undergone reversed intestinal segment to slow intestinal transit. Two patients underwent intestinal transplantation. Two patients have died: one from parenteral nutrition-related liver failure and the other after intestinal transplantation. Crohn's disease remains a common cause of SBS. Aggressive resectional therapy, surgical complications, and errors in initial diagnosis contribute to development of SBS in these patients. Selected patients are candidates for surgical therapy for SBS.

Adolescent↗